Weight-Loss Surgery for Adolescents?

The long-term effectiveness of weight-loss surgery in pediatric and adolescent patients is not known, as it is not yet known either in adult patients. But the profits are clear, and the willingness of payers, including Medicaid, is apparent.

Twelve-year-old children cannot be responsible for providing their own caloric intake, so their obesity must result from their parents’ overfeeding them or allowing them to overeat above their caloric needs and expenditures, and to develop their food addiction. The fault here is with the parents, not the children.

A bowel-altering and life-changing operation on a child to address a problem of the parents may represent another new echelon of medical misadventure that in the not too distant future will be regarded with shame and dismay, on a level with prefrontal lobotomies and other egregious rights violations.

Drastic responses to disease may be effective by one measure, but their legitimacy and ultimate utility may be more costly in human terms than justifiable.

Your article serves to reinforce that the Lap-Band, a surgically inserted silicone band that constricts the stomach, is simply a surgical tool and not a panacea for obese people. Indeed, while it is an excellent choice for patients who need extra help in losing excess weight, it will not work without significant associated behavioral modifications.

This is especially true for adolescents, who also require an aggressive psychosocial program, with support for the patient and the family.

They need to understand the importance of follow-up and lifestyle change. Without regular monitoring — and without true commitment and effort from the patient — the Lap-Band will not be successful. Moreover, all patients interested in weight-loss surgery should have a consultation with a surgeon who can also discuss a full range of surgical procedures as well as medical options.

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Olimpia Zagnoli

AURORA DAWN PRYORStony Brook, N.Y., Jan. 9, 2012

The writer is a professor of surgery and director of the Center for Metabolic and Weight-Loss Surgery at Stony Brook U.

To the Editor:

How sad that our medical system allows bariatric surgery for young adults and that our insurance system pays for it (a 25-minute procedure costing $21,369 was covered). What is more troubling is how badly some people live when we know the behaviors necessary to live a healthy life.

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Eating whole grains, fresh fruits and vegetables, no processed foods and daily exercise are key. We are aware of the risk factors for heart disease and diabetes, and we know how to prevent these disorders. And yet our “health care” system allows for bariatric surgery rather than insisting upon prevention.

Think of the money saved if insurance companies and our medical system included the services of wellness coaches and personal trainers, who can teach people how to set and accomplish goals.

We must prevent the obesity epidemic in this country, which is leading to the increased incidence of diabetes and heart disease. People do not become overweight or obese overnight. The patient in the article insisted upon eating mashed potatoes and dumpling skins. Is this the direction Medicaid and medicine should be going in?

The writers are, respectively, a psychiatrist; and an epidemiologist and wellness coach.

To the Editor:

Qualified health care professionals know that weight loss is a big business and a slippery slope in the cure department. Your article about Shani Gofman’s struggle to be thin, which highlighted her weight-loss surgery, was touching but also disturbing in that it avoided mention of psychotherapy, which is well regarded as a gold standard ancillary treatment.

LESLIE SMITH ROUSELLDarien, Conn., Jan. 9, 2012

The writer is a psychotherapist.

To the Editor:

I am surprised that your article did not mention the development of an eating disorder as one of the risks of weight-loss surgery for adolescents. Apart from the physical dangers the article mentioned, this psychological pitfall could be the main reason to proceed with caution.

The article did mention that Shani Gofman vomited after meals following her surgery, but it did not discuss the specter of bulimia that this scenario clearly raises. If we are truly concerned about these kids’ well-being, this is not something that we can ignore.

RACHEL WYNERTel Aviv, Jan. 9, 2012

The writer is a graduate student in psychology.

A version of this letter appears in print on January 16, 2012, on Page A22 of the New York edition with the headline: Weight-Loss Surgery for Adolescents?. Today's Paper|Subscribe